Does Concomitant Degenerative Spondylolisthesis Influence the Outcome of Decompression Alone in Degenerative Lumbar Spinal Stenosis? A Meta-Analysis of Comparative Studies

Abstract

Objective: To investigate whether the preoperative presence of degenerative spondylolisthesis (DS) worsens the outcome of patients undergoing decompression alone for degenerative lumbar stenosis.

Methods: We conducted a comprehensive search in the PubMed, Embase, and Cochrane Library databases. All comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The functional outcomes were clinical scores and reoperation rate. The radiologic outcomes were slippage rate and postoperative instability rate.

Results: A total of 11 studies with 1081 cases, including 469 cases of degenerative lumbar stenosis with DS (DS group) and 612 degenerative lumbar stenosis without spondylolisthesis (noDS group), were enrolled in our meta-analysis. There were no significant differences between the 2 groups for functional outcomes in terms of Japanese Orthopedic Association score, Japanese Orthopedic Association recovery rate, Oswestry Disability Index score, visual analog scale back/leg, and reoperation rate after decompression alone. For the radiologic outcomes, slippage rate was found not changed significantly before and after minimally invasive decompression alone in the DS group and the postoperative instability rate did not differ significantly between the 2 groups after decompression alone by a minimally invasive method.

Conclusions: Our meta-analysis revealed that concomitant DS (Meyerding grade I-II) does not influence the outcome of decompression alone in degenerative lumbar spinal stenosis, especially when a minimally invasive procedure was performed and patients did not have predominant symptoms of mechanical back pain. The presence of DS should not be an indication for fusion surgery in degenerative lumbar spinal stenosis.

Keywords: Comparative study; Decompression; Degenerative spondylolisthesis; Lumbar spinal stenosis; Meta-analysis.